Revitalize Energy and Mental Health with Miles Nichols, DAOM

Episode 84:

Revitalize Energy and Mental Health with Miles Nichols, DAOM and Evan H. Hirsch, MD

Evan H. Hirsch, MD 00:00

Hey everybody. Welcome back to the energy MD podcast where we are helping people

who've got chronic fatigue MECFS, long COVID and M casts. So I'm really excited today

because we're going to be talking about infections with Dr. Miles Nichols. So let's learn a

little bit about him. So he's a functional medicine doctor specializing in Lyme mold, gut

thyroid and autoimmunity. After Dr. Miles personally struggled with chronic fatigue in his

early 20s, he dedicated himself to figuring out the root causes he suffered with and

recovered from thyroid dysfunction, autoimmunity, a gut infection, Lyme co infections

and mold illness. Dr. Miles. Thanks so much for joining me today. Thanks so much for

having me. It's a pleasure to be on. So let's talk a little bit about infection. So when

somebody comes into your office, what makes you think that they would have an

infection that you need to treat?

Dr. Miles Nichols 01:00

That's a great question. I assume that a lot of people probably have infections, but that

not everyone needs them treated. So it's about pattern patterns of symptoms. And

some of that is about physical signs. So part of it is patterns of symptoms. Part of it are

physical signs, part of it is doing a comprehensive case history and hearing what people

say and certain things that I've learned to stand into or to if people tell me a certain

thing, and I asked some more questions about it, for example, when symptoms started

on set for them. And if I uncover that there wasn't an obvious trigger that was either

environmentally related or that was related to some kind of something that that or

traumatic event or stressful event, if we can't find those things, I start to think I wonder if

infection may have been a part of the onset of symptoms for this person.

Evan H. Hirsch, MD 02:10

Yeah, that's a really good point. Because people could have infections in their bodies for

long periods of times without symptoms, right? And then all of a sudden, they get

symptoms.

Dr. Miles Nichols 02:18

Absolutely. And there could be a variety of ways in which the immune system could

modulate or other things could happen that could allow those symptoms or that

infection to take hold.

Evan H. Hirsch, MD 02:29

And what do you feel like? What do you feel like are some of the biggest infections that

you find and people who have chronic fatigue

Dr. Miles Nichols 02:41

with chronic fatigue, there's viral bacterial and parasitics of categorically, those three

fungal to some degree, although I would say the other three categories a little more so

under bacterial I would say that very common Borrelia burgdorferi, or lime does disease

and Bartonella is another very common one on the bacterial front. Parasitic, we see

Babesia is one very common on the parasitic front and then certain other parasites that

are probably hard to diagnose. I see some nematodes and certain worm infections and

things like Entamoeba histolytica are other parasitic infections that can play a role.

Some of them are hard to diagnose. And then on the viral side, Epstein Barr reactivation

COVID or post COVID, there can be general viral load that we're really not sure some

stomach biopsies are showing and taro viruses in stomach biopsy, but they're hard to

test for in the blood. And those may be very related to chronic fatigue as well.

Evan H. Hirsch, MD 04:00

And do you find that it's usually one infection or do you find that people have multiple

infections

Dr. Miles Nichols 04:07

more generally, multiple often, you know, in the pattern of when I'll look, many people will

have antibodies to some infections, they've had history of infections, they've gotten

better. Often, when people are struggling with chronic fatigue, I'll find antibodies against

many different infections. If we do a viral panel we may find three or four viral

antibodies. A lot of people have Epstein Barr Virus antibodies, but we might find also

cytomegalovirus antibodies we might find hh, V six antibodies, we might find some

pattern of several together. And then we might find on the bacterial side streptococcal

antibodies, antibodies to Lyme bacteria, antibodies to Bartonella. We might find five or

six or so Seven different infection, antibodies and someone struggling with chronic

fatigue not all the time, but a lot of times I'll see that pattern.

Evan H. Hirsch, MD 05:09

And so then so that a how do you unwind that bad ball or unwrap that? That onion? How

do you go about addressing all of them? Do you find you have to address all of them? Or

do you find that there's a linchpin that ends up support getting rid of the other ones?

What do you what do you see?

Dr. Miles Nichols 05:29

Well, depends. And that's a funny answer, because no one likes it. But but it does

depend. I mean, sometimes it's it sometimes infection setting, due to other things that

are just regulating the immune system. And you get rid of those other things a toxin

accumulation, a significant mitochondrial issue, significant nutrient deficiencies that are

enduring the processes in the body by which the body might get rid of infections and

infections naturally resolve sometimes it's not even direct treatment of infections. And

sometimes there is direct need for treatment of infections enough to get them down, at

least enough for the immune system to kick in and manage those infections. And

sometimes that's just one primary infection. And sometimes it is even multiple classes

of infections like there is some need to both treat some bacterial and some parasitic

infections before that immune function can start to take care of the rest of what's there

usually don't have to go down the list of every single infection and treat every single one

though.

Evan H. Hirsch, MD 06:40

Yeah, I would agree. And it seems like I have more success getting rid of infections

when I'm also addressing the heavy metals, the chemicals molds. Do you find that also

and why do you think that's the case?

Dr. Miles Nichols 06:56

Yeah, absolutely find that. And as I was just saying that sometimes you take care of

something else in the immune function can take care of infections, I think that's a big

part of it. We know mold, illness can create this chronic inflammatory response engine

that can highly dysregulated immune function. And so if we can resolve that

inflammatory process immune system function can improve the body's defenses

against infection may be able to take care of infection, to some degree or to a better

degree, in tandem, sometimes Wisam infection treatment, but definitely, toxin

accumulation leading to dysregulated immune function plays a big role. And that's both

ways immune depletion for defense against infection, as well as immune activation

against self or tissue, autoimmune processes, or auto antibodies seem to often be

related sometimes to infections, toxins, both infections, and toxins. Sometimes the

Gatun foods and other things too, but oftentimes infections, toxins, metals, as well

playing a big role in the body's capacity to be able to manage immune function,

infections. And so metals can absolutely also get in the way create inflammation, create

problematic immune dysregulation that can contribute to it being a lot harder to get rid

of infections, and especially if some basic infection treatment is failed, I find that that

that mold toxins that metals that that accumulations in the body, will be significant in

helping to get rid of the infection at that point.

Evan H. Hirsch, MD 08:50

And so, you know, I struggle with lab testing for some of these for that very reason, you

know, you're talking about how heavy metals, chemicals, molds, and even infections will

cause a dysfunctional immune system. And you also mentioned that, oftentimes, when

we're when you're doing some testing, you're looking at antibodies to some of these

infections. So how do you rationalize asking a dysfunctional immune system to give you

an accurate read on some of these tests?

Dr. Miles Nichols 09:21

I mean, labs are part of a puzzle and you know, clinically, it becomes, it becomes there's

an art and there's a science to it. And and as lab testing improves over the years, we

may get better lab testing, but for infections right now at it, I agree, it's not perfect, and

we can get some good lab evidence for exposure and that's kind of where I use labs

related to infections bar to get evidence for exposure, and then I want to have a

symptom match. And then I want to see some responsiveness to a type of a treatment

that I would expect to be helpful on infections. And if I have all three, I'm pretty

convinced infections are an issue. And we don't need to repeat a lot of those labs,

although I do like to have some assessments that help with tracking progress. And

those are more functional tests that are going to be helping us to get a sense for

improvements objectively, while subjectively people are also reporting how they're

doing, and if they're improving and getting better. So some of those are, are really easy,

really low cost, like a visual contrast sensitivity test or a VCs test, someone can do it at

home from their computer, it's looking at subtle changes in the eyes ability to detect a

very small color contrast. And that's been associated with impairments in that ability to

detect contrast had been associated quite strongly in research with biotoxin,

accumulation, mold exposure, and the damage to the visual centers that can occur from

those. And so if we see those improving, that's a great, inexpensive, easy at home way

without a lot of effort, and investment to track progress together with some research

validated questionnaires that can be fantastic for tracking a person's experience and

how it changes. Because sometimes people forget, it's I remember sitting down with a

patient and she said, you know, it was really frustrated, things aren't getting better. I'm

just feeling like, really, like I'm not improving, and what are we doing here? And I said,

Well, let's, let's look at it. And let's, let's think about it. And I said, Well, how are the

headaches? And she said, What headaches? And? And I said, Well, that was the primary

reason why you came in in the first place where your headaches? And she said, Oh, I

haven't. I forgot about haven't had them in a long time. And she was like, Okay, well,

some things are changing then. And the mind is good at forgetting problems. And I think

that's a good thing, a good function of the mind. Forget the problems of yesterday. But

sometimes a research validated questionnaire can be helpful to know okay, what is

changing? Even if the focus isn't on those things that have been yester your problems or

yesterday problems? We want to know, are they shifting, are they changing. And so

research validated questionnaires can be helpful for that. And also some lab tests,

some visual contrast sensitivity tests, or certain inflammatory markers. Certain lab

markers that are proxies are indicators of immune function, even just simple stuff,

tracking white blood cell changes, or looking more complex stuff at markers, like

neopterin is an interesting marker that can be associated with infectious activity,

indirectly, that gives us part of that chain. And if we see that improving, or going down,

that could be a sign that infections are getting better. So I like to have a couple tracking

markers that we can do objectively and subjectively. And then, of course, we can add in

other elements for people who would be a fit for like, muscle testing would be one, and

we can look at other ways of, of assessing together in dialogue, what's happening,

what's improving what's changing.

Evan H. Hirsch, MD 13:17

Yeah, I love the way that you brought in all those different ways of data collection. You

know, oftentimes I'll tell people, you know, history, symptoms, labs, response to

treatment, I'm super glad you brought that up. And then muscle testing. It's like, these

are all imperfect data markers, but together, they give us a better picture. Would you

agree with that?

Dr. Miles Nichols 13:38

Absolutely. And it does become a picture or a pattern, there's a sense about it, of what is

mainly going on. And that is part of the art of medicine, not just the science. And so

putting together all these different data points into a tapestry and looking at that

tapestry as a whole. And just having for me, I just get a feeling like this is a little more of

an infectious dominant tapestry at the moment, and not that that won't change, but that

this other one is a little more of a toxin dominant tapestry at the moment, this one is a

little more, you know, gut dominant at the moment. And that guides the focus of

treatment, not that we won't address multiple areas at a time, but you know, we can't

and there's no need to address everything all at the same time.

Evan H. Hirsch, MD 14:28

Right. Yeah, I think that's important that a lot of people don't realize that that we do want

to look at all of the causes. And oftentimes you get rid of a number of them, it frees up

the immune system, it can help get rid of the other infections. So I'm really glad that you

brought that up. You mentioned research validated questionnaires, you're talking about

m SIDS, or what do you like to use?

Dr. Miles Nichols 14:49

Yeah, with infections. MC IDs is a great one for the toxin and mold CRS questionnaire is

a is a nice one that that can be used in and And so those two I use a lot. I like the MS. Q

is a general sense for overall toxicity or symptom picture. So Ms. Q is another one.

There are some ones like NIH validated questionnaires like the promise 29. I don't like it

as much for what it is it's but it's highly research validated. So it's good from a research

perspective. But really Ms. QM, SIDS, and SIRs are my main go to three questionnaires

that I use.

Evan H. Hirsch, MD 15:31

Nice. So let's talk about mood, and infections. How do infections influence people's

mood?

Dr. Miles Nichols 15:42

This is something that I feel so passionately about that I was, I had started a summit

called microbes in mental health and to really look at this connection, mental health

issues and concerns have largely been thought to be neurotransmitter imbalances in the

brain, serotonin deficiency changes in dopamine. And that's been kind of where research

and where pharmaceutical interventions have been focused on are these

neurotransmitter changes in the brain. But recent research coming up has shown that

there may be very little to no connection between things like serotonin depletion and

depression. And that's pretty shocking. It's been pretty shocking to a lot of clinicians and

researchers that, that the evidence is fairly weak if one umbrella review would it's so

strongly as to say there's no evidence, there's no good evidence, or the overarching

umbrella review of looking at it all says, there may be no connection between serotonin

depletion and depression. And this just throws a lot of questions out as to well, then

what, what is causing things like depression and anxiety and some of the, you know,

OCD and these issues, these mental health issues that are arising and becoming more

and more significant, and trauma and PTSD or complex trauma that isn't PTSD, that's on

a spectrum, that may be maybe a huge chunk of the population, if we, if we broaden it to

complex trauma are struggling with that. And when we're looking at this, and we're

looking at causes, I mean, there, there, there is no pin, pin the tail on the donkey exact

for sure this is the only cause. But there's a very strong body of evidence that there's a

cytokine theory for depression, where inflammation. cytokines are proteins that are

inflammatory in nature. And there's a very, very strong body of research and evidence

now that show that inflammatory markers in the blood go up symptoms of depression,

correlate and go up. And then inflammatory markers go down symptoms of depression

go down. In many cases, not every case, but in many cases, so then it begs the question,

well, what causes systemic and chronic inflammation? Now we're starting to see okay,

well, infections and toxins and gut microbiome changes and, or diet and certain lifestyle

changes and exposure to chemicals, and we start to get this tapestry of things that are

contributing to chronic inflammation. And then we look at some research that shows a

direct effect of infections on the brain. So we see for example, strep or streptococcus,

so we see strep being one bacteria that can directly impact the brain and brain function.

And that for some people, there's now a whole diagnostic category called pandas, for

children, pediatric autoimmune acute onset autoimmune neuropsychiatric disorder. It's

a mouthful but basically what it says is kid get strap a few months later, starts to exhibit

behavioral changes isn't doing well in school is getting in trouble is getting into fights is

not focusing is maybe getting an AD D ADHD diagnosis or an OCD diagnosis or is

starting to develop a lot of food intolerances and sensitivities or is starting to get

anxious or depressed and there's a good body of evidence stowing and suggesting that

strep can onset an auto immune process against some brain structure, like dopamine

receptors in the brain or tubulin in the brain, or certain other structures that relate to

behavior that relate to mental health and that the initiation of this bacteria can actually

directly cause inflammation in the brain or indirectly cause the immune system to attack

the brain that can then lead to what we call neuro inflammation. that can lead to

behavior change that can lead to mood changes that are significant. And that's not only

strep. Now there's a new category also called pan's not just pandas, but pandas and

pans is saying, Actually, it's not just strep is not only caused by streptococcus, it's

actually we know Lyme, we know mold toxin can initiate this process. We know that

Epstein Barr Virus can initiate this process, some influenza strains can initiate this

process Bartonella bacteria can initiate this process so many different infectious

causes for the immune system and some people to start to attack the brain structure

and function. And also, other mechanisms by which these infections can cause

systemic inflammation that can lead to neuro inflammation that can contribute to

anxiety, depression, may contribute to complex trauma may contribute to a variety of

mental health issues and mood dysfunction.

Evan H. Hirsch, MD 21:05

Yeah, it's it's such important work that's being done. And I really appreciate your

awareness bringing, bringing this to the forefront with your Summit. You know, my part

of my story is that a number of years ago, my wife started getting panic attacks in the

middle of the night. And I had just started learning about a number of these infections.

And I was like, Well, I know that the BCA can cause anxiety to the point of panic attacks.

And she was also having some sweats and some shortness of breath. And I was like,

let's go ahead and treat you. And so we treated with her with herbs. And we got rid of

her panic attacks, you know, she had had them for about a month straight before we

had started treating and they went away very quickly. So it's, it's really exciting to kind of

have this knowledge and have tools to get rid of some of these things. And so I guess I

would ask, you know, what sort of what sort of mood you talked about, like ADHD and

OCD, being associated with strep? What, what? What infections are associated with

some of these different symptoms and diagnoses?

Dr. Miles Nichols 22:11

Well, commonly, depression and anxiety are really, really common with infections. And

we can see there are patterns and that the Vizio, like you mentioned can be anxiety or

frustration kind of rage, even sometimes some big ups and downs and swings. We see

some other ones associated more with the chronic fatigue depression picture. Epstein

Barr seems to be more associated with that fatigue and depression side, Lyme can go

either way, I see, you know, more of an anxious picture in some individuals more of a

depressive picture and other individuals and sometimes anxiety and depression can go

together to people can have an underlying sense of chronic fatigue, brain fog,

depression with an anxious, wiry, frustrated kind of a over pinning to it. So some

infections seem to overlap in that, but certainly I I see a lot of viral associations with the

chronic fatigue, the heaviness the depressive the lows, and I see some of the bacterial

parasitic infections like the bees, Babesia, Bartonella and Borrelia or Lyme being

associated often with these, these hyper vigilant kind of an overstimulated anxious type

of frustrated and, and and stress Euston. Not that people will say, you know, Dr. Mild

stress used to really not bother me, people could kids could do stuff and, and spill

something or drop something or break something that wouldn't be a big deal. And now I

find myself I'm having to hold myself back from yelling at my kids. And that's really hard

to see in myself and this kind of thing I see a lot, you know, or I feeling anxious all the

time, all the time, hard to relax, hard to go to sleep, or to feel like I'm myself anymore. I'm

getting triggered all the time by things that are happening in my life. And we could call

that anxiety, we could call that complex trauma. But this picture I see with these, the

Lyme and CO infections of Lyme, I see often associated with that hypervigilant, kind of

anxiety type of pattern.

Evan H. Hirsch, MD 24:38

So let's talk a little bit about parasites. So, where do parasites fit in this whole equation

in terms of I guess, and I guess the bigger picture is in terms of how do you determine

which infection to go after first? So I guess, maybe answer that question first, and then

we can talk a little bit more about parasites.

Dr. Miles Nichols 25:00

So that is a complex question that does combine. I mean, there's a lot of case history

that goes into that question, taking good history and seeing what When did when did

stuff change for a person? How did it change what was going on around that time, like I

was just chatting right before this interview with a patient who she had had this onset

many years ago, of right after a bullseye rash and unknown tick bite, she had a

significant onset of neurologic symptoms and mental emotional symptoms that got

diagnosed actually, as Ms before, they figured out that it was actually Lyme, causing

these symptoms. And Lyme treatment was very successful in helping her reregulate, but

then just recently, she's now having this severe fatigue picture. Well, we have known

lime trigger, but right before this severe fatigue picture, she got COVID for the second

time, and, and this fatigue picture, as opposed to that earlier picture looks a little more

viral in nature. So so I'm emphasizing viral first with her, but she also got gut symptoms

at the same time. So we're going gut and viral as a beginning with her, although we

know Lyme is there. We know it's historic, maybe it got reactivated. But because of the

picture and the pattern, the onset and the timing, were focused viral first in her case. So

it does depend a little bit on the pattern, what it looks like if it for someone, if it is

cyclical, and it seems like it's worse around the full moon and it does get worse at night

versus during the day, then parasites might be a first choice in that particular pattern or

picture. So it's some of the understanding the nature of these different kinds of

infections. If someone says, Hey, I really have heavy legs, and my feet are burning, and

my temperature is up and down, and I have a really hard time. I'm not menopausal. But

I'm waking up with night sweats, I'll save Well, let's look at Babesia. First, sometimes it's

just it fits the pattern of that infection. It doesn't always come that way. But sometimes

there's just knowing the patterns. And the symptom Association has people say me a

stiff neck and, and joint pain that moves around and it's just different, you know, day in

and day out, and there's no rhyme or reason to it. And my moods are fluctuating, and I'll

often think, lime and especially if there's some, some also neuropathies, and some

tingling and numbness. And so again, you know, it's knowing these patterns and getting

a sense for which kinds of infections and to present in which ways, but there's a lot of

overlap, too. So it gets confusing quickly.

Evan H. Hirsch, MD 28:00

Do you think that people need to have had traveler's diarrhea or traveler's constipation or

have been to a second or a third world country in order to have parasites? Or do you

think that they can get parasites here at home?

Dr. Miles Nichols 28:16

I mean, I, I absolutely think parasites can be contracted here at home. And

Evan H. Hirsch, MD 28:24

there's,

Dr. Miles Nichols 28:26

it's really hard with lab testing, sometimes I don't see on lab testing parasites, but a

person is presenting with a parasite pattern. And parasite treatment makes them feel

better. And it's very hard for me to think there aren't parasites in that case. But also I

have found one lab that that finds a lot in stool that there microscopy seem to be quite

good. So So I'll run some stool tests and find quite a number of of, and sometimes it's

just the larvae, they just find the larva of a nematode of one of the worms. And they it's

just a little bit of larva. But that leaves us in that this may be going on. And I see that

enough in people who I can't for sure say they can tract it locally, because a lot of people

do traveled at some point in their life, internationally. And did they pick it up? And it's just

been at such low levels? You know, I don't know. But I'd say it's, it's a lot more common

than I would think and it doesn't, it presents in a lot of people who who tell me that they

weren't. They didn't get sick when they travel. So they wouldn't suspect the travel if even

if they have traveled internationally to be related to when the onset of symptoms

occurred. And so it's less suspicious of a time for contracting although, who knows

maybe it was contracted then and it just didn't present and symptoms until something

else came up and imbalanced the system enough to have that set in.

Evan H. Hirsch, MD 29:58

Yeah, and so many of these causes these infections can be from mom to baby through

the placenta, right? So it's hard to know sometimes where they where they get these

from

Dr. Miles Nichols 30:11

in pets. And you know, there's lots of Yeah, absolutely.

Evan H. Hirsch, MD 30:15

And so what's the name of that company that does the good parasite stool test?

Dr. Miles Nichols 30:20

Well, they're they're actually called parasitology. Center. So nice, cool PCI, or

parasitology. Center? Yeah.

Evan H. Hirsch, MD 30:30

Yeah, that's a hard one. I tell people generally that about 1% of all parasites that are

present will show up on a stool test. So I'll have to take a look at that test. So and then

what is your what is your favorite testing to do and looking at infections.

Dr. Miles Nichols 30:50

I like a lime coinfections panel, especially if I'm suspecting that there might be one of

those Borrelia, Vizia, Bartonella, Ehrlichia, Anaplasma, rickettsia, any of these kinds, I'll

use the vibrant wellness tickborne and coinfections panel or the iGenex, five IBL panel,

are my top two go to DNA connections has a urine PCR test, that with provocation can

be good as well. So those are the three if looking just for Bartonella. Galaxy labs can be

good, but I really mostly use vibrant wellness and Biogenics with occasionally some

DNA connections or galaxy.

Evan H. Hirsch, MD 31:38

And do you find that if it shows up negative, but the symptoms are highly suspicious,

that you still treat? And if so, do you find that it's a little bit of a harder sell? Because the

labs are negative for the for the client to accept?

Dr. Miles Nichols 31:55

Yeah, absolutely. And especially true for, for some of the CO infections seem to be like, I

see a lot of things that present like Bartonella and Bartonella does seem harder to show

for whatever reason on those labs and and I do see it show sometimes when it does it

gives it does give people that confidence that feeling that okay, we know there's we're

we're pretty confident least there's been exposure, immune systems making antibodies,

why else would it gives people a little more like confidence to to spend the time energy

and effort to go through a treatment process, but we absolutely will sometimes say, you

know, what, Bartonella did not show in the lab, but presentation and the responsiveness

to treatment so far looks a lot like Bartonella. So we're gonna go ahead. And if people

respond well to that, too, and when it's done in a way that's informed and with

experience, and the conversation and dialogue is had, and I like to make sure people do

feel included in the collaborative care process. It's not just, you know, I'm telling you

what to do. It's the that we're collectively deciding, you know, your body better than I do.

And I have some information that might be valuable, and we're looking together in

dialogue, to work on things, and that we're not going to limit ourselves only to what we

find on that data, we're going to consider a variety of different perspectives as well.

Evan H. Hirsch, MD 33:20

Yeah, it's such a wonderfully balanced approach. So in terms of going after infections,

do you find that you have to prepare the body in certain ways in order to be more

successful? And if so, what does that look like?

Dr. Miles Nichols 33:34

Sometimes, and sometimes not a most of my infection treatment involves supportive

elements, built within even formulas, for example, for using an herbal formulation that is

targeting Lyme and CO infections, we may within that formulation design, there's

actually some support for adrenal function support for building up the Yin or the young

in the body from the Chinese medicine perspective. So so so there, there's this sense

that that there are herbs that are more supportive than they are fearing or inhibitory or

anti infectious or anti microbial, and there are herbs that are more focused on anti

microbial side and there's a balance of the so I usually like a balanced approach to

treatment, that there's immune supportive focus on top of infection suppressive focus,

because we know inevitably, at the end of the day, even hardcore antibiotics don't 100%

Eliminate infection that the immune system at some point has to finish the job and has

to take hold. So if we can bolster and support the immune function while reducing and

inhibiting the infectious enough for the immune system to be bolstered. I like that

approach. I don't like only antibiotic antimicrobial approaches without any supportive

elements, I don't find most people respond very well to those. And I also don't

particularly see the best results to only supportive without some infectious reducing

less, it's, you know, we clear out some other stuff like toxin accumulation like heavy

metals, and then that might free up enough to deal with infections. But if unless we have

another blocking something, just a supportive element, I don't usually find to be enough

on its own. But some people don't tolerate the balanced and if they don't tolerate the

balanced at first, then supportive first followed by the balanced second is my general

approach.

Evan H. Hirsch, MD 35:57

And what is your opinion about a Herxheimer reaction? Or a die off reaction? Is it

necessary to have that sort of reaction when you're killing an infection? Or do you feel

like you're able to do it without having a Herxheimer reaction?

Dr. Miles Nichols 36:14

I consider responsiveness to treatment to be one of two things. And one of those is a

Herxheimer type of reaction. But the other one is simply improving significantly with out

the need necessarily for excimer reaction. So it can go either way. To me

responsiveness. Treatment is what I tell people, okay, what we're looking for, as you

begin this treatment is one of two things, either you get some amplification of

symptoms, or some old things start to come back, almost like an unraveling, or it's

significantly different than your day to day normal ups and downs. And that could also

look like you just are significantly better, your energy is significantly improved, your

mood has lifted, your heaviness in your body is lifted, you feeling more energy. So these

kinds of things are also totally viable. And sometimes, it's, I mean, honestly prefer it if it

can happen that way. And it can many times, I believe that too much of a Herxheimer

detox reaction can actually be harmful. So I don't, I don't encourage people to push. You

know, there are some Doc's and I think it's fine for for someone to go this route, if they

want to if they feel called to Barisan docs that say like, you know, quit your job and, and

don't, you know, work for a year, and you're going to be miserable. And we're going to do

this treatment, if you resonate with that fine, but that's not my approach. My approach is,

I want you to be functional. And I want you to be getting gradually a little more

functional. That doesn't mean there aren't some downs along the way. Yes, down and

up, down and up, down and up, but overall, trending generally up. That's to me, what

were the style of treatment that I like. And so I want people to feel like, if they're looking

on a monthly basis, that they're generally having more good days than they did the

previous month. And that that doesn't mean there won't be some periods of a few days

or a week when they feel miserable. But I don't want that to get in the way of them

functioning in their day to day life or destroying their relationships or, you know, I think

sometimes more harm can be done than good in in some of these very aggressive

treatments, strategies.

Evan H. Hirsch, MD 38:35

Yeah, I agree. I tell people I want you to this much hurts, you know, so we know that

we're killing something, but not so much that you're, it's taken a toll on your adrenals and

your hormones and your mitochondria. Exactly. So you had talked about antibiotics now,

but you don't prescribe antibiotics correct.

Dr. Miles Nichols 38:57

And we do have someone in the office who manages the that piece of things and so we

can use those it's not a big part of what we do. So typically, yeah, we'll use some

pharmaceuticals that are helpful but antibiotics aren't a big part of mine treatment or CO

infection treatment, they're more a case by case kind of rare thing that we'll add in

periodically.

Evan H. Hirsch, MD 39:29

And what about parasites Do you find that prescriptions are better than herbs or vice

versa?

Dr. Miles Nichols 39:37

Yeah, when it comes to parasites actually i i have found the opposite clinically where

pharmaceuticals are often often a utilized and a first go to in the clinic here we we seem

to see that a lot of people who even have tried multiple rounds of have herbals will

respond to a nicely a nicely designed pharmaceutical parasite formulation. So I'd say we

use that a lot more on the farm side than we do on the other infections like Lyme co

infections.

Evan H. Hirsch, MD 40:22

And which antiparasitic do you find you're using most of these days? Prescription ones?

Dr. Miles Nichols 40:30

Yeah, we like. Often we'll use a combination. And many times it'll be three together. And

ivermectin is one that we found to be quite nice. And we'll use ivermectin in combination

with two others, sometimes one other. Sometimes it kind of depends on the person, the

parasite. So there are a couple of different ones that we'll use. But typically we like to

find a combination of ivermectin together with often. I ran tell Pam Wait, and

Praziquantel are probably the two other most common ones that we'll use.

Evan H. Hirsch, MD 41:20

Yeah, that's really interesting, because I think that that's more common than people

think that. You know, there's a lot of parasite protocols out there that sometimes work

and sometimes don't. And sometimes when they don't work, it doesn't mean that you

don't have parasites, it could mean that you need a different treatment. Absolutely.

Yeah. Let's talk. Let's get really practical here. Well, actually, we're just about out of time.

And I know that you've got to, you've got another call coming up here. So why don't you

tell people this has been really great, valuable information? I so appreciate it. Let me

pick your brain. I've learned a bunch today. Can you tell people about where they can find

and learn more about you, and then a little bit about your free gift?

Dr. Miles Nichols 42:04

Absolutely. So my clinics name is medicine with heart and website is medicine with

heart.com. So easy one to remember. And there's a great blog, we put out articles on a

weekly basis, totally free. So I highly encourage people to check out the blog at

medicine with heart.com. And then you can also if you're interested in finding out more

about working together, you can chat with a staff member, you can book a discovery

consultation to chat with a staff member about what it looks like to work with the clinic

and if you'd be a fit or not. And then when it comes to the gift were put together a guide.

And this guide is quite comprehensive, I think on looking at the research and the

perspectives and the clinical findings for the associations between infections and the

brain, especially mental health issues. But also neurologic symptoms, including chronic

fatigue, including brain fog, including headaches, including cognitive decline, memory

issues, things like Alzheimer's dementia. So it's really looking at that brain connection

with infection, some of the research that's associated with that some of the practical

things, labs and supplements and things that we found effective. So it is called

microbes and mental health and we'll be offering that guide for your listeners.

Evan H. Hirsch, MD 43:32

Awesome. Thank you. Yeah, we'll drop those links below. Dr. Miles, thank you so much

for joining me today. I really appreciate you coming on.

Dr. Miles Nichols 43:40

Dr. Evan, thank you so much for having me. Take care and have a wonderful day

everyone.